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Chizuko Ueno on Dying at Home

In Japan, the rebellious spirit of retired Tokyo University sociology professor Chizuko Ueno has long been beyond dispute. Petite and slim at 66, she is an internationally renowned feminist thinker. For the past four decades, she has been one of the most influential, outspoken and fearless leaders of the Japanese women's movement.

In Japan, where women are supposed to be "kawaii," Ueno is proud that she gained notoriety because, "I'm critical, I'm assertive, I'm disobedient."

In 2007, Ueno's book Alone in Your Old Age became a bestseller, selling more than 1 million copies and gaining the status of a "bible on old age." In a scholarly article, Ueno once observed the book sold so well "probably because many people recognized that living one's old age alone can happen to anyone."

Ueno resembles the child in the fairy tale "The Emperor's New Clothes" who blurts out in front of the crowd that the Emperor is wearing nothing. The unpleasant fact that Ueno draws attention to is that most people, regardless of whether they married or stayed single, will be alone in their 80s or 90s. Moreover, most older people cannot or do not want to live with their children.

After retiring as a professor, Ueno, who sports a head of short-cropped hair, moved to Mitaka, a city about an hour's drive away from downtown Tokyo. "My interest has already shifted to how to die, instead of how to get old," Ueno says with an unhurried, steady voice. "I am aging myself, and also now we [Japanese] need to face death more than before."

In her living room, Ueno has reserved a corner for photographs commemorating family and friends who have passed away. Framed pictures of her late parents and a close friend who died from cancer last year are prominently displayed.

No Doctor Needed in the Last Hours of Life

Japan has recently reformed its medical and old-age care system, and it will have a negative impact on the aged people, Ueno says. The government decided not to increase the number of hospital beds, and elderly people can only move into nursing homes if they require Care Level 3 or above. Considering the fact that more than 50 percent of old people live alone or with an equally old spouse, "dying alone at home" is a new practice that Japanese people may have to learn, Ueno believes.

She points out that before the 1970s the majority of Japanese actually died at home. Dying in hospital has become the norm only in recent times because society holds that "death in the hospital means the children have tried their best."

Ueno believes that aside from medical emergencies such as a stroke, there is no need to seek medical attention, and in a "hyper-aging society" very few deaths are actually unanticipated.

"For a peaceful death, you don't need any doctors," Ueno contends.

In April, Ueno, who never married and does not have children, began to write a series of articles in the newspaper Asahi Shimbun, titled "Alone in Your Death." In these essays, she recommends that people living alone should prepare for their death by setting up a support team. Such teams should include a community medical team, care manager, care workers, relatives, friends, lawyer and financial advisor. The team should assist the person in arranging for death and dying, such as setting up a will.

Japan has already established a community-level system of "Joint Service Provider Meetings." Twice a month long-term care managers, physicians, nurse practitioners and occupational therapists get together to discuss their cases.

Nonetheless, Ueno frankly admits that the idea of dying at home is still a very new concept.

As a result, relevant resources vary considerably from place to place. In order to enable people to live out their lives at home, communities must provide reliable round-the-clock in-home care, in-home nursing, and terminal care. All three services are essential, so that in an emergency the right person can be reached. But this is not the only obstacle.

"The bigger problem is that family members still insist on taking [a dying old person] to hospital," Ueno says.

Having challenged the values and traditions of Japanese society her whole life, Ueno has not mellowed after retirement. When it comes to facing the process of dying, she is still at the forefront of her age.